LETTERS; The Deadly Choices at Memorial

Published: September 13, 2009

It is futile to second-guess the grand jury and wrong for us now to judge Dr. Pou, Dr. Cook and some of their associates guilty of crimes for what they did in the crucible of Katrina. But it does seem that the American Medical Association's rush to judgment on their behalf, Dr. Pou's P.R. campaign and portrayal of herself as a victim and the air-brushing of her own role in administering the injections suggest a startling lack of candor. Her ongoing efforts to redefine the meaning of Do Not Resuscitate orders and change public policy and medical standards, perhaps to justify what went on at Memorial hospital, demands close scrutiny if not outright condemnation.

MARTIN J. GLEASON
Washington

As described by Sheri Fink, Anna Pou's contribution to the debate regarding disaster preparedness is extremely troubling. She has endorsed the idea of using a patient's Do Not Resuscitate order as a means of triage assessment, but this is an ethically dubious proposal. D.N.R. orders are intended to guide care under extremely specific circumstances, i.e., when a patient's heart or lungs are no longer working. A healthy 18-year-old can have a D.N.R. order in place -- it has no bearing on that patient's desire to survive an emergency situation. Likewise, the contention that informed consent is impossible during disasters is flawed and potentially dangerous. There are situations in which informed consent is not possible, but these circumstances hinge on the capacity of a patient to communicate and understand his or her decisions. To strip a mentally competent patient of the right to informed consent is patently indefensible under most if not all imaginable circumstances.

From the events as they occurred at Memorial to the subsequent grand-jury hearing, the best that can be said is that poor decisions were madebased on biased or incomplete information. I hope that as our country prepares for future emergencies, our efforts willbe guided by objective, unbiased participants and with due representation of medical patients and their interests.

ALEXIS BONEPARTH, M.D.
Brooklyn

Who is to blame for what occurred at Memorial? Obviously, the author is pointing a finger at Dr. Pou. Her biggest sin was remaining at the hospital and not leaving, the way her colleagues Dr. Cook and Dr. King did. LifeCare's executives in Texas were fully aware that the majority of their patients were medically fragile and would need more resources than normal to evacuate and yet failed them.

After working under horrendous conditions, including lack of sleep, lack of electricity to keep modern medical machines working, shut-down elevators and an unsanitary working environment, the remaining staff members at Memorial did what they could. It would behoove all to use what happened at Memorial as a reason to rethink disaster plans for hospitals and nursing homes. A triage plan must be developed and publicized to the community.

President Obama says that the lack of quick government response that added to one of the worst disasters in any of our cities in modern history will not occur again. It would be interesting to read what is now in place that wasn't in place then to assure this will not happen.

PAT KOSMALSKI
Granville, Ohio

Kudos to Dr. Sheri Fink for the compelling and nuanced description of the first few days post-Katrina at Memorial Medical Center. The ethics of medical decision making in crisis situations warrant debate and discussion -- here in the United States as well as globally. While I am uncomfortable passing judgment on health care workers who stood steadfast in the midst of a terrible crisis, I am unable to condone their actions toward certain patients. Respect for patient autonomy is a basic ethical principle in medicine, one that appears to have been grossly violated in New Orleans. The development of guidelines and training for health care workers to face future crises is imperative.

SUNEETA KRISHNAN
Women's Global Health Imperative
San Francisco

Dr. Sheri Fink's expos?f the homicides committed in New Orleans is a long-overdue disclosure of the events that happened after Hurricane Katrina hit the Louisiana coast in the early morning of Aug. 29, 2005. Any objective review of the hospital records, investigative reports and toxicological analyses of the patients who suddenly, inexplicably and conveniently died during a four-hour period while waiting to be evacuated on Sept. 1 conclusively proves that these individuals were euthanized. The nature and quantity of the medications that were found in their systems were unquestionably inconsistent with the subsequent contrived rationalization offered by Dr. Anna Pou, i.e., that she was simply attempting to alleviate their physical suffering and allay their anxiety.

In our book, ''A Question of Murder,'' my co-author Dawna Kaufmann and I have published the toxicology test results of these unfortunate long-term patients. As far as I know, these forensic findings were not presented to the grand jury, nor were any of the experts consulted by the attorney general of Louisiana, Charles Foti, or the coroner of Orleans Parish, Frank Minyard, called to testify.

Justice was not served in New Orleans, nor does it appear likely that any of the Louisiana authorities are considering picking up the cudgel at this time. I commend Dr. Fink and The New York Times for having the courage to reveal this horrendous tragedy to the attention of the world.